Rania Naguib

Caroli’s disease (CD) and Caroli’s syndrome (CS) are rare congenital fibropolycystic liver disorders. While CS is known to be associated with more severe hepatic complications than isolated CD, direct longitudinal comparisons between the two entities remain limited due to their rarity. This single-center, retrospective, longitudinal observational cohort study descriptively compared clinical features, complications, and long-term outcomes in 19 patients diagnosed with CD ( n = 7) or CS ( n = 12) between November 2015 and December 2022. Diagnoses were confirmed by magnetic resonance cholangiopancreatography. Patients underwent standardized clinical, laboratory, endoscopic, and imaging assessments during follow-up. Outcomes included recurrent cholangitis, portal hypertension–related complications, hepatic decompensation, cholangiocarcinoma, and all-cause mortality. Statistical analyses were descriptive and exploratory. Patients with CS exhibited more frequent portal hypertension, lower platelet counts, higher bilirubin and international normalized ratio levels, and lower serum albumin compared with patients with CD. All cases of esophageal varices, hepatic decompensation, cholangiocarcinoma ( n = 3), and death ( n = 3) occurred exclusively in the CS group. Exploratory analyses demonstrated monotonic associations between adverse outcomes and higher aspartate aminotransferase levels, increased frequency of cholangitis episodes, thrombocytopenia, and elevated CA 19 − 9 levels. Kaplan–Meier analysis showed shorter median survival in CS compared with CD (45.0 vs. 59.0 months; log-rank p = 0.020), which should be interpreted descriptively given the limited sample size. In this descriptive longitudinal cohort, Caroli’s syndrome was associated with a more severe clinical course and poorer outcomes than isolated Caroli’s disease, consistent with existing literature. These findings provide detailed comparative outcome data and highlight clinically relevant patterns that may inform surveillance strategies and guide future multicentre, hypothesis-driven studies. Graphical Abstract

Objective: To quantify hepatic steatosis and visceral adiposity in active Cushing’s syndrome (CS) using magnetic resonance imaging (MRI), evaluate associations between hypercortisolism and MRI-derived fat metrics, and characterize the relationship between hepatic and visceral fat compartments. Subjects and methods: This retrospective cross-sectional study assessed 36 patients with biochemically confirmed active CS. Hepatic proton density, fat fraction, and visceral adipose tissue area were quantified using chemical-shift encoded MRI with semi-automated segmentation. Biochemical assessments included serum cortisol, adrenocorticotropic hormone, liver enzymes, and lipid profiles. Results: MRI-defined hepatic steatosis (fat fraction ≥6.25%) was identified in 69.4% (25/36) of patients. Those with steatosis exhibited higher serum cortisol levels (832.9 ± 347.8 vs. 581.2 ± 331.9 nmol/L, p = 0.049) and greater visceral adiposity (35.0 ± 8.0 vs. 23.9 ± 6.7 cm2, p < 0.001). Serum cortisol positively correlated with visceral fat area (r = 0.512, p = 0.001) and inversely correlated with liver signal intensity index (r = -0.424, p = 0.01). Visceral adiposity demonstrated a strong positive correlation with hepatic steatosis grade (r = 0.601, p < 0.001). Conclusion: Hepatic steatosis was highly prevalent in active CS and closely linked to hypercortisolism and visceral adiposity. These findings support a mechanistic coupling between central and ectopic fat accumulation. Integrated MRI-based fat quantification provides a non-invasive, radiation-free approach for refined cardiometabolic risk stratification in this high-risk population.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a novel group of oral medications used to treat type 2 diabetes mellitus (T2DM). Nonalcoholic fatty liver disease (NAFLD), a complication of T2DM, is now recognized as one of the most frequent causes of chronic liver disorders. We aimed to investigate the effects of SGLT2is on hepatic function and glucose homeostasis in patients with T2DM and comorbid NAFLD. To our knowledge, this is the first study in the Arab region to compare the effects of SGLT2is and other antidiabetic medications and to evaluate the outcomes after a 6-month follow-up period in this patient cohort. This cohort study involved 100 patients with T2DM. The patients were divided equally into two groups. The exposed group comprised 50 patients receiving any of the SGLT2is (empagliflozin or dapagliflozin); the non-exposed group comprised 50 patients taking any other oral antidiabetic medication (other than glucagon-like peptide-1 receptor agonists or SGLT2is). The outcomes investigated were glycemic control, hepatic function, and liver fibrosis parameters, investigated at baseline and after 6 months. Significant improvements in glycemic control, hepatic function, and fibrosis parameters were observed in the SGLT2i group after 6 months, as evidenced by laboratory and clinical data (p < 0.001). Significant improvements were observed in hemoglobin A1c, Fibrosis-4 index, gamma-glutamyl transferase level, alanine aminotransferase level, and NAFLD fibrosis score (p < 0.05). The findings indicate that 6 months of SGLT2i therapy improved fibrosis and glucose homeostasis in patients with T2DM and NAFLD. Therefore, SGLT2is are effective therapeutic agents in this patient population.

Introduction: The number of working Saudi women is significantly increased. Many women go through menopause when in employment. This work aims to assess the severity of menopausal symptoms (MS) among working Saudi women. Methods: A cross-sectional study of Saudi women working at Princess Nourah bint Abdulrahman University (PNU), aged 45–55 years. It is a self-administered questionnaire about the Menopause Rating Scale assessing the severity of MS and their effect on the work. Results: 11.8% of participants had severe/very severe MS; the most common MS were irritability, anxiety, depressive mood, and sleep problems. There was a significant association between osteoarthritis and joint pain of MS. MS that had a negative impact on work were tiredness/lack of energy, sleep disturbances, mood swings, joint and muscular aches followed by irritability/anxiety, and hot flushes/sweating. There was no statistically significant association between the severity of MS and body mass index or marital status or educational level, occupation, income, medical conditions, or physical exercise. The majority of women at PNU found that the work environment had a minimum negative impact on their MS. The most common strategies to manage MS at the workplace were wearing appropriate clothing and getting more information about menopause. The actions that help improve the workplace to cope with MS were flexible working hours, better ventilation, air-conditioning, and temperature control, access to informal support at work, and administration awareness of menopause as a health problem. Conclusion: Working Saudi women have mild-moderate MS. The work environment at PNU had a minimum negative impact on MS.

Objective: This study aimed to estimate the risk of cardiovascular disease (CVD) among patients with and without diabetes mellitus (DM) using the Framingham risk score (FRS) and to investigate the effect of DM control on CVD risk. Methodology: A total of 2432 participants who had their glycosylated hemoglobin (HbA1c) measured within the last three months were included in this study. The study cohort was divided into three categories: non-diabetic, participants with controlled DM (HbA1c< 7%), and uncontrolled DM (HbA1c≥ 7%). The World Health Organization’s stepwise approach to chronic disease risk factor Surveillance-Instrument v2.1 was used in this study to collect the anthropometric and biochemical measurements. The Framingham Coronary Heart Risk Score (FRS) was used to calculate the 10-year cardiovascular risk (CVR). The groups were compared concerning the prevalence of metabolic, socioeconomic, and cardiac risks. Results: Out of 2432 participants, 149 had controlled DM (6.1%), 286 had uncontrolled DM (11.8%), and 1997 participants were normoglycemic (82.1%). Compared to healthy participants, diabetic participants showed more high-risk characteristics across all CVR parameters. Uncontrolled diabetic patients had a graver laboratory and clinical profiles compared to the controlled DM group. As measured by FRS, nearly half of patients with controlled DM (49.9%) and two-thirds of patients with uncontrolled DM (63.3%) were classified as intermediate and high-risk compared to 4.6% of the healthy participants. Compared to healthy participants, patients with controlled DM showed a threefold increased CVR (OR = 3.02, 95% C.I. = 1.41– 7.24) while this risk catapulted to 13 times among those with uncontrolled DM (OR = 13.57, 95% C.I. = 6.99– 26.36). Conclusion: Participants with DM are at moderate to high CVR. Individuals with uncontrolled DM showed higher CVR profiles as measured by FRS and have a higher prevalence of obesity, unhealthy diet, and physical inactivity.

Background and Aim: Renal function is noticeably altered in both hypothyroidism and hyperthyroidism. However, clinical studies on thyroid dysfunction and its association with renal function are scarce. The purpose of this study was to evaluate changes in biochemical parameters of renal function in subjects with thyroid dysfunction and to correlate these values with the patient's thyroid profile. The effect of changes in thyroid function during therapy on renal function was also investigated. Methods: A prospective cohort study included 41 patients with untreated primary hypothyroidism and 16 patients with untreated hyperthyroidism. Thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine were assessed using immunoassay. The estimated glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. Renal function tests were assessed in all patients at each of the two-time points: during thyroid dysfunction (hypo- or hyperthyroidism) and after attaining euthyroidism. Results: Our study demonstrated a statistically significant reduction in the average serum creatinine level in the hypothyroid patients after treatment compared to before treatment whereas the mean estimated glomerular filtration rate (eGFR) significantly improved after treatment compared to before treatment. Moreover, the average serum creatinine level in the hyperthyroid patients was significantly lower before treatment compared to after treatment, whereas the mean eGFR significantly dropped after treatment. TSH had a significant positive correlation with serum creatinine and a significant negative correlation with eGFR in all patients with thyroid dysfunction. Conclusions: Thyroid dysfunction is associated with deranged kidney function. It is crucial for the clinician to be aware of the link between thyroid disorders and aberrant renal function in order to consider a thyroid function test when treating a patient whose biochemical markers of renal function are only mildly elevated. There is a need for monitoring creatinine in patients with thyroid dysfunction.

Sheehan’s Syndrome in a Fifty-Six-Year-Old Woman Presenting With a Retroperitoneal Mass: Perioperative Management During a Major Surgery